MEDICARE: TWANA JOY THOMAS LPC-I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	84875	TX

General Provider Information

NPI Number	:	1386240497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TWANA JOY THOMAS LPC-I

Provider Business Mailing Address
First Line	:	805 GARDEN PATH DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6811
Country	:	US
Telephone Number	:	765-603-3567
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 MENCHACA RD STE 202
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5373
Country	:	US
Telephone Number	:	765-603-3567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	12/05/2020

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